Healthcare Provider Details

I. General information

NPI: 1134606544
Provider Name (Legal Business Name): TRIANGLE PAIN CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HEALTH PARK STE 109
RALEIGH NC
27615-4731
US

IV. Provider business mailing address

8300 HEALTH PARK STE 109
RALEIGH NC
27615-4731
US

V. Phone/Fax

Practice location:
  • Phone: 612-999-7759
  • Fax:
Mailing address:
  • Phone: 919-322-2064
  • Fax: 919-322-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AYSEL ATLI
Title or Position: MD
Credential:
Phone: 919-322-2064